Provider Demographics
NPI:1619041498
Name:COHEN, WAYNE T (MD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:T
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 HARBOR PARK DR
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-4602
Mailing Address - Country:US
Mailing Address - Phone:516-883-7100
Mailing Address - Fax:516-883-7474
Practice Address - Street 1:488 GREAT NECK RD STE 300
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4308
Practice Address - Country:US
Practice Address - Phone:516-482-6747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167750207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01145064Medicaid
NY01145064Medicaid
NYE17286Medicare UPIN